We address healthcare reform and the business intelligence required to make strategic decisions that positively affect performance management, employee engagement and process effectiveness. We'll dabble in current trends, news, training and business acumen and issues. Our desire is that you learn from the talented people who contribute to our blog. Please leave comments so we can learn from you!
In the article, Success On A Community Hospital Budget , the editors of Healthcare Technology Online share the honest realities of three community hospitals that have implemented EHRs. The three panelists share their unique financial and IT staffing limitations due to their size and locations. The panelists are all decision makers:
Frank Beaman, CEO, Faith Community Hospital with 41 Beds
Charles Brobst, CFO, Saint Anthony Hospital with 151 Beds and
Anwar Botros, Director Of IT, Saint Bernard Hospital with 194 Beds
I can understand why Faith Community chose Prognosis HIS that is geared to the community hospital market. However, while these knowledgeable men share their tips for success, I have some reservations as to why a small hospital would consider implementing a closed system when they have access to VistA for less money and would be easier to implement and maintain.
Call me naïve, but I think a multi-million install, one which is on the low end for systems like MEDITECH, etc. are costing these days, is MIGHTY HIGH when one considers the fact that the systems not interoperable with other systems. So far I have yet to hear about the perfect system that is reasonably easy to install and implement on time and on budget.
Shouldn’t there be alarms going off in the heads of board members, CEOs, CTOs and CFOs all around our country? I’m still waiting for regulators to DEMAND that EMR and EHR systems HAVE TO BE interoperable to get certified. What is driving their buying decisions when it comes to EHR or EMR systems?
I’m really searching for answers here, and open to dialog with anyone who can help me understand this issue. Being a bottom-line gal, maybe I’m missing something? As a CEO of a small company, I just can’t imagine making a decision to buy a system that I know will be super costly, perhaps so costly resulting in my hospital having serious financial issues in the near or far term, when I know that I could get the job done for MUCH less money, fewer people resources, easier training, etc.
Yes, VistA has less bells and whistles and isn’t as “pretty” as the big boys”, but we can provide excellent patient care without the bells and whistles - - and shouldn’t patient care be the driving reason behind implementing any new process or computer system?
Many of you may have heard
that The Centers for Medicare and Medicaid Services and Office of the National Coordinator for Health Information Technology held a “listening session” in Washington on May 3, 2013. The meeting was with stakeholders to discuss EHRs and billing. Hmmm…I bet many of you weren’t invited.
You may also have heard that The American Health Information Management Association is urging more research on the causes of higher levels of coding and reimbursement through the use of electronic health record. Sue Bowman, Senior Director of coding policy and compliance, hasreiterated their view, “The extent to which EHRs have led to improper reimbursement is unclear. EHRs produce more complete and accurate documentation and this could be leading medical providers to seek reimbursement for services they have always been providing, but weren’t properly documenting before. Higher levels of reimbursement do not necessarily equate to fraud.” [Good for AHIMA to share this very important tidbit the government bean counters must have overlooked when they estimated disbursements from their mandated EHRs!]
I’ve written several articles on coding the past year, emphasizing the issues that will and are resulting from too complicated a coding system. Here's one you might like to check out. IDC-10 Codes, There's Got to Be a BETTER Way!
This latest round about coding is a perfect example of the documentation mess we're in, except in the reverse. Now physicians are getting accused of seeking higher reimbursements because their EHRs are allowing them to more accurately document all the services they are providing - which are legally billable, by the way! Look at this from the physician’s side: They have expensive EHRs they've been mandated to implement. Now they have a capability to document and bill for all their services that they probably missed billing in the past due to “user/billing errors.” Doesn't it make sense that they would bill for all the services they provided - thus helping them pay for their EHRs, employee training, lost productivity, etc? Wow, if you’re healthcare provider in today’s healthcare world, you’re placed in a position of being “damned if you do and damned if you don’t.”
This reminds of our of complicated tax system. For those of us lucky enough to hire a good CPA, we can deduct everything coming to us, but those who can’t afford such professional services, you’re left to filing your taxes with only “street” knowledge that you’ve gathered over the years. And oh yeah, what you’ve learned may or may not be applicable to the newest tax rules, so you’re increasing your chances of being audited by the IRS.
Now back to Ms. Bowman... She’s recommending the development of a code of ethics for EHR vendors and users to design and use the system appropriately, guidelines to ensure features in an EHR are correctly used, development by CMS of a national set of coding guidelines for hospital reporting of emergency department and clinic visits, and education and training on coding with EHRs.
Forgive me, but on the vendor’s side, shouldn’t this be part of the licensing process for EHR software? There will always be some unscrupulous people in all professions, but is it necessary to make more laws to make sure docs are coding correctly? Remember, the new codes haveincreased from 13,000 to 55,000! Getting all the coding done correctly will be like finding a specific shell on the beach. There's a good chance you'll find the wrong shell? Coding accuracy will be a myth!
I would welcome dialog on the issue. It’s a big one for me and I’m hoping it gets you riled up a bit to!
I’ve done some “unscientific” surveying of the issue of Transparency in Healthcare and was surprised by what I found. While we often blame the older docs of being inflexible and holding back in the transparency arena, I run across docs of all ages who know that healthcare delivery must change. There are the gutsy docs willing to put their heads above the fray and open themselves up to scrutiny by their peers and patients. They ask the hard questions, pressing for why we’re still teaching and practicing medicine the same way. They ask the question of why we don’t review our standard procedures using Lean methodologies to see how medical professionals can save time and money and improve patient care.
As with any change, there are those individuals that still need to be brought over to the “light side.” Forgive my Star Wars analogy… There are still MANY doctors, old and young, who still have the “I went to medical school and thus know more than anyone else in the room. I like what I do now and don’t want healthcare to change – or at least don’t want my work to change.”
I don't have much advice for how to change the attitudes of the second group, except to:
Keep the drums pounding…in a nice way of course.
Allow naysayers to stand back and watch the changes happening around them but not too long. At some point, they will need to get on the bus, or the changes will pass them by.
Medical School Experiences that Show Leadership Transparency
Medical students experience both types of leadership: Transparent and Autocratic. They see firsthand transparent leadership from some docs’ autocratic leadership from those docs unwilling to open up and flex, even a little, to allow the students learn from the docs’ personal experiences that would bring the subjects to life. Yes, students are taught to memorize, assess quick, make quick decisions, but that's a different topic to address later.
As a trainer and teacher, I love to hear of times when professors share the good, the bad and the ugly with their students. It’s from these real-life experiences that the “light bulbs” turn on around the room. These professors show a transparency that shows they are “real people” working at a complex job with many variables. It helps give the students a better idea of what practicing medicine will be like from them after their LONG training journey.
Don’t jump to conclusions here, I’m not suggesting breaking HIPAA laws, just doctors showing a bit of vulnerability.
Unfortunately, in medical school, the time is so short to teach the students all the theory and science needed to practice medicine, instructors in the classroom and hospital use an autocratic teaching style to get through as much of the content they can. There isn’t time to allow for much “self-discovery” or independent thinking. That will come later when they have more experience under their belts.
Signals that Change is Not Easy for MANY
In our EMR/EHR consultancy, we see the flexible doctors willing to attend training whenever it is convenient for the organization. The inflexible doctors are the ones that still want to be trained one-on-one. My opinion is that these physicians don’t want "transparency" because they don't want others to know what they don’t know. It would bump them off their know-it-all pedestal and down with mortal men. You can’t blame them. I’m not being flip – honest. No one wants to be treated by a doctor who they think doesn’t have all the answers and thus can’t cure them. Patients choose to be treated by docs they perceive to be “the” experts. What’s sad is that these same docs and patients are kidding themselves. No one can know everything about every topic – even in their particular specialty. A very skilled doctor may know more than the next 20 people, but new information is found every day and no one has the time to learn everything new every day and keep up with their patient load.
I have the utmost admiration for those who choose the medical field as their choice of profession. It is often a lonely, selfless job that keeps practitioners away from their families and forces them to trade “personal time” for being on call at night, weekends and holidays. It is, however, time for all healthcare professionals to take a good look and accept that our world, our patients and healthcare delivery are changing. Hopefully more healthcare professionals will choose improved, transparent, care delivery by involving others, especially holding patients ultimately mutually accountable for our own care.
It’s not a one-way street – patients need to change, as well.
The time is now that patients must start taking responsibility for how we treat our bodies and learn how they work. Ok, so in a perfect world, patients would know that "we are what we eat" and also know that we all need exercise and a will power to avoid things that harm our health. If we do this, doctors will have a much easier time treating our illnesses and helping to make us healthier. Sounds logical to those of us "A" type personalities, but we have a long way to go to get here!
Please share your experiences with us about doctors – young and not so young – who are modeling transparent healthcare. I know they are out there. If you are a champion of transparent healthcare, please let us hear from you so we can learn from you!
Here’s a short list of my current transparent healthcare heroes. These docs are in the trenches speaking out for reforming healthcare delivery. They have all earned the right to be heard.
I just had to share this short video, Someone Who Cares , I received in my email from Simple Truths. If you're inspired by this simple act of kindness shown an elderly man by a sentitive nurse, I'd recommend you check out Simple Truths . Mac Anderson is a great guy who's videos and books will bring a smile to your face a warm feeling to your heart.
How would you like your organization to be among the top 10 Places to Work? Well, Fortune Magazine surveyed 259 firms and more than 277,000 employees to find out how they would rate their organization for management credibility, job satisfaction, camaraderie, pay and benefits, hiring practices, communication, recognition, and diversity, but only one healthcare company ended up in their top 10.
The 10 most common answers were no surprise to any of us who follow transparent leadership methodologies, but my favorite “extra” was learning that one CEO posts his/her personal development plan for all employees to see and track results.
This Leader ROCKS! (in my humble opinion...)
While the survey was aimed at all types of corporations, not necessarily healthcare, CHG Healthcare Services ranked third on the list of Best Companies to Work For. Wouldn’t it be great if several hospitals, especially those that have or are currently implementing Lean Healthcare, would be ranked in the top 10 for 2013?
The facts are overwhelming that the most important asset we have is our employees and that all organizations should strive to hire the best candidates they can find to fill needed gaps. One process that is effective for building a best-in-class workforce is consciously hiring people who have skills and knowledge otherwise lacking in the organization - that of course includes hiring for IT and leadership expertise, as well. By doing so, you build a solid company where everyone appreciates and learns from their peers and leaders. It also fosters employee satifaction and patient satisfaction while grooming high potentials for leadership positions.
So healthcare leader, are you brave enough to post your personal development plan for all your employees and peers to see:
What you don’t know now but are trying to learn?
How they are being led by someone who might not be as knowledgeable as they presumed?
What you feel is important for you to become a better leader?
And, oh yeah…
That you’re not perfect, all knowing, etc.?
Trust me, most leaders would be scared to death to let their employees and peers reach into their secret little minds and learn the real truth about them. But folks, we need to step up to the plate and begin modeling transparent leadership so the people around us will feel free to do the same.
Once we all become transparent, we can begin the natural progression of everyone helping each other grow and our organizations and people will benefit socially, personally, professionally and financially. Can’t beat that!
Promoting Transparency beyond our walls:
None of us wants the negative publicity of being linked to lack of transparency. How is your organization rated for pricing transparency? Patients want and deserve to know what they will be charged for procedures. As patients are becoming more informed, they are choosing to be treated at hospitals that willingly publish their fees. For healthcare organizations to be considered best in class, they need to swallow this poison pill and advertise their pricing.
You might want to read this article about Arizona state getting an “F” because price of services are hidden from the public: Arizona gets failing grade for healthcare transparency . I have to believe that healthcare professionals in Arizona work hard to provide excellent patient care; but even so, their hospitals now have a definite black spot on their reputations.
Drum Roll Please: Who will be the first person to step up and comment below:
“Yes, I will post my personal development goals for my peers and employees to see. I will begin the process of encouraging transparency within my healthcare organization.”
“Yes, we will change our pricing policies and post the cost of our services for easy access.”
I think many of our readers will want to check this upcoming IT conference to be held in San Francisco. If nothing else, perhaps many of us can get out of the snowy east and midwest. Seriously, the presenters and topics look great!
"The 2013 iHT2 Health IT Summit is less than 30 Days away! Don't Miss this opportunity to join over 200 CIOs, VPs, and Directors of IT from hospitals, health systems, and larger physician practices.
Program Highlights:
Data Analytics in Healthcare - Featuring Kaiser Permanente, Catholic Health Partners & More
Evolution of Clinical Decision Support - Featuring Mayo Clinic, Dignity Health, Lucile Packard
Meaningful Use Stage 2 - Featuring CalHIPSO, Department of Public Health - San Francisco & More
mHealth Apps & Patient Engagement - Featuring Aetna, West Health, UCSF School of Medicine & More
How will the 2013 iHT2 Health IT Summit in San Francisco benefit you?
Learn best practices for leveraging data at the point of care, and how to get the most out of your EHR data
Discuss strategies for securing mobile devices and understand how to assess responsibility for PHI
Address best practices for improving performance & outcomes and understand how you can use Clinical Decision Support to meet new standards of care
Understand how Meaningful Use standards impact ACO operations and success, and the role the new ICD-10 will play in providers understanding their practices and outcomes
Discover mHealth tools that reinforce the provider-patient relationship, and best practices for integrating mHealth data into existing EHR and system infrastructure
Still Looking for Reasons to Attend?
We understand your time is valuable. Now more than ever, iHT2 is committed to providing programs which promote improvements in the quality, safety, and efficiency of healthcare through information and information technology.
Interested in attending or just learning more about the iHT2 Health IT Summit in San Francisco or upcoming Summits in Atlanta, Boston, and Fort Lauderdale? Please contact Matthew Raynor at matt@ihealthtran.com or call 561-748-6281.
iHT2 HIT Connect Interview:
Davin Lundquist, MD
CMIO
Dignity Health Medical Foundation
How has Dignity Health Medical Foundation benefited from using CDS (Clinical Decision Support) systems?
We have some basic CDS tools in place within our EMR, most related to medication ordering as well some meaningful use reminder alerts. We also use templates in our documentation to help prompt providers with what questions to ask patients who come in for particular types of visits or with particular problems. We have some order sets and a few care guides related to wellness visits. I would categorize all of these as “First Generation” Decision Support tools. We are actively pursuing technologies that will help us get to what I would call “Second Generation” Decision Support tools that are much smarter and actually incorporate patient specific information and prior results to prompt physicians with more point of care and contextual support for managing patients and their diseases.
Hear from Davin Lundquist, MD and more than 35 other C-Suite Health IT Leaders at the iHT2 Health IT Summit in San Francisco, March 26-27th at the Hyatt Regency San Francisco Airport
Click Here to View the Agenda
Click Here to Read the Interview in its Entirety
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While the author talks about the system and how it will process information, I'd suggest that the EMR systems of the future must go way beyond being a sophisticated database with natural language query. With millions of data point of knowledge growing with every discovery and new drug treatment, we will need our computers to go well beyond "holding and processing data". Undoubtedly, it will need NLP, but in addition, the software will need to contain ALL current, up-to-date information and be able to logically guide providers' clinical decisions. Think of the space movies of the past.
For you Star Trek fans, I bet if you listen, you'll quickly the remember the onboard computer. The sounds you heard were that of Majel Barrett-Roddenberry's voice. Remember how Captain Kirk and his crew simply asked the computer questions and it instantly offered suggested solutions to their problems? "She" even provided the probability of success for each option. Our computers need to do that same thing plus much more.
And on a side note, wasn't the voice recognition a nice touch? Today we have iPhones that correct our spelling and the Siri application, a natural language, intelligent personal assistant, that is able to process data and verbally answer our most obscure questions. This technology is no longer out of reach. Why aren't EMRs using these options to improve care delivery? Not to appear ungrateful for the IT programming to date, but our current EMRs are simply VERY expensive data storage tools.
If our iPhones use the latest technology, why don't our healthcare systems? Think about it, Siri adapts to the user's individual preferences over time and personalizes results. It performs tasks such as finding recommendations for nearby restaurants, or getting directions. Wouldn't similar technology be helpful for providers to have at their fingertips? Not the restaurant look ups...but you know what I mean!
While it's nice for Siri to be able to tell me every turn I should make on my drive across country, a robust computer system that guides healthcare delivery decisions on the spot would certainly be more earth-shattering that a woman's voice telling us how to find the local eatery.
So Mr./Ms. IT professional, please tell us what you're working on now to improve/upgrade our current EMRs. We truly depend on your expertise and believe that you can build the computers of the future that will revolutionize healthcare delivery and improve patient care!
Exciting stuff for sure!
Please let me and our readers here from you -- I truly welcome comments! Conversation is the best way for us to learn from each other.
TBD Consulting has a proven track record for ensuring staff and physician adoption of EMR/EHR system implementations as well as Lean Healthcare. Whether you need assistance to create a training department or organizational change department, help your existing training organization meet the needs of the ongoing changes, or simply need "extra hands" to meet your deadlines or ROI goals, please contact Jonena. She and her qualified staff are here to assist you with your organizational development, coaching and training initiatives.
Don't miss Jonena's addition to the HWR. Gone
are the days when American medicine was ranked head and shoulders above ALL other
healthcare systems around the world. One only needs to watch the up-tick on medical tourism to see that there is a plethora of
qualified healthcare providers beyond our borders. EMRs and EHRs are the US healthcare system’s way of
dipping their toes into 2013. We MUST go beyond getting our toes wet. We need
to implement change methodologies and Lean tools and processes that will guide
all healthcare employees - clinical and non-clinical alike - to participate in
and take responsibility for continuous process improvements within their spear
of influence. Read the entire post.
